Horners syndrome is a rare condition characterized by miosis constriction of the pupil, ptosis drooping of the upper eyelid, and anhidrosis absence of sweating of the face. A complete physical and neurologic exam, radiographs xrays, a biochemistry panel, complete blood count cbc, and a ct scan or mri will help determine the cause. Horner syndrome is a rare condition that affects the nerves to the eye and face. The causes of horners syndrome varies with the age of the patient and site of the lesion. She had dysphagia but did not have hoarseness, dyspnoea or thyrotoxic symptoms. This paper presents a case of horner syndrome due to a haemopneumothorax following penetrating chest trauma. A 63yearold woman presented with a right anterior neck mass that enlarged rapidly over 2 months. Feb 03, 2020 care guide for horner syndrome in children. Horner syndrome is an uncommon but important clinical entity, representing interruption of the sympathetic pathway to the eye and face.
We advise, therefore, to obtain a mr angiography scan in all acute acquired horner s syndrome with thirdneuron lesion. It can cause drooping eyelid, small pupil, and decreased sweating on the affected side of the face. This condition results from lesions that interrupt the sympathetic nervous supply to the head, eye, and neck. Horners syndrome, the triad of miosis, ptosis, and enophthalmos, is a common complication of regional blockade of the brachial plexus, following disruption of sympathetic nerve input from the cervical sympathetic ganglia 1 a. If you have problems viewing pdf files, download the latest version of adobe reader. The affected eye will have an abnormally small pupil. Horner syndrome, oculosympathoparesis, anisocoria, ptosis, anhidrosis. The development of horner syndrome following a stabbing. Horner syndrome knowledge for medical students and. There s no specific treatment for horner syndrome, but treatment for the underlying cause may restore normal nerve function. Jun 19, 20 horner syndrome horner syndrome hs is oculosympatheticparesis loss of sympathetic innervation to the eye no major loss of ocular function vision and pupil reflexes remain intact the disorder is largely asymptomatic and oftenclinically subtle little need for therapeutic intervention hs may be caused by lesions associated.
There is minimal documentation that the horners syndrome can be reversed if successful treatment of the. Despite such knowledge, the incidence of underlying malignancy in children with hs remains unclear and robust. A central horner syndrome caused by damage to any of these structures is. Ansari sa, parmar h, ibrahim m, gemmete jj, gandhi d. Congenital horners syndrome jama ophthalmology jama. The patient in horner s case exhibited miosis, partial ptosis, enophthalmos and changes in the vasomotor and sudorific activity of the face. Most cases of hs are idiopathic, but conditions such as brainstem stroke. Horner s syndrome is classically characterized by a triad of miosis, partial ptosis and anhidrosis. Horner s syndrome, the triad of miosis, ptosis, and enophthalmos, is a common complication of regional blockade of the brachial plexus, following disruption of sympathetic nerve input from the cervical sympathetic ganglia 1 a. It can have many different symptoms, such as small pupils or droopy eyelids. The etiology is due to an interruption in the sympathetic innervation to the eye. Firstorder neurons are located in the posterolateral hypothalamus, and from there, sympathetic fibers pass through the lateral brain stem and extend to the ciliospinal center of budge and waller in the intermediolateral gray column of the spinal cord at c8t1 figure 2. Selective mr imaging approach for evaluation of patients with. Hs may be a subtle sign of occult pathology in otherwise asymptomatic children, neuroblastoma nbl being the the most common associated malignant tumour.
Mar 14, 2019 the trigeminal autonomic cephalalgias are a group of primary headache syndromes marked by severe head pain and associated cranial autonomic symptoms which can include a full or partial horners syndrome. It is important to seek immediate care if you develop other problems, such as head or neck pain. Introduction the term horner syndrome is commonly used in english speaking countries, whereas the term bernardhorner syndrome is common in france horner syndrome horners syndrome results from an interruption of the sympathetic nerve supply to the eye. Apr 05, 2008 how to examine a patient with horner s syndrome, get my new may 20 interactive book on your ipad. Horners syndrome is characterized by certain facial asymmetries, mainly involving the eye. Horners syndrome is a group of signs that occurs due to damage of the nerves that innervate the muscles of the face. Objective horners syndrome hs is characterised by a triad of ocular miosis, ptosis and anhidrosis. The underlying causes of horner s syndrome vary greatly and may include a tumor, stroke, injury. Horners syndrome usually results from a lesion to the sympathetic pathways that supply the head and neck region. Horners syndrome is easily diagnosed by the presence of the signs listed above.
In rare cases it has been witnessed after intercostal regional anesthesia. Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection cadiss. The patient in horners case exhibited miosis, partial ptosis, enophthalmos and changes in the vasomotor and sudorific activity of the face. Horner syndrome consists of unilateral ptosis, an ipsilateral miotic but. Horner syndrome causes problems on one side of your face when the nerves there are damaged. Horner syndrome classically presents as ipsilateral miosis. The condition is characterized by the sinking of ones eyeballs into the orbital cavity and. It may also have a droopy upper lid andor an elevated lower lid, and have a lighter colored iris than the other eye. Unilateral horner syndrome following epidural anaesthesia. Oct 10, 2017 horners syndrome is also known as oculosympathetic palsy and bernardhorner syndrome.
Pdf horner syndrome is an uncommon but important clinical entity, representing interruption of the sympathetic pathway to the eye and face. Pdf horners syndrome is classically characterized by a triad of miosis, partial ptosis and anhidrosis. Among the other causes of horners syndrome are head and neck surgery, trauma and puncture of the internal jugular vein. However, it is often difficult to determine the cause. The basic triad of horners syndrome consists of relative miosis pupillary con. Bacon c l et al 1996 bilateral horner s syndrome secondary to metastatic squamous cell carcinoma in a horse.
If horner syndrome is likely, magnetic resonance imaging mri or computed tomography ct of the brain, spinal cord, chest, or neck is done to look for tumors and other serious disorders that may be disrupting nerve fibers connecting the brain and the eye. Sep 22, 2015 in children, unless there is a known aetiology such as birth trauma, acquired horner s syndrome requires thorough investigation. Transient horners syndrome associated with hypertension eye. Answer your doctor or an eye doctor ophthalmologist can do tests to see if you have horners syndrome. The condition sometimes results from an injury to the nerve but it can also be present from birth. Answer horner s syndrome causes problems on one side of your face when the nerves there are damaged. Jan 03, 2017 horner s syndrome is a rare condition characterized by miosis constriction of the pupil, ptosis drooping of the upper eyelid, and anhidrosis absence of sweating of the face. Horners syndrome nord national organization for rare. Horners syndrome genetic and rare diseases information center. The condition is caused by an injury to a nerve that controls that side of the face. Horners syndrome is a common condition in veterinary patients, particularly in dogs and cats, presenting with the typical features of miosis, enophthalmos, protrusion of the third eyelid and ptosis. To assess the usefulness of mr in the ealuation of patients with horners syndrome. The treatment of horner syndrome depends on the location and cause of the. The trigeminal autonomic cephalalgias are a group of primary headache syndromes marked by severe head pain and associated cranial autonomic symptoms which can include a full or partial horners syndrome.
Dogs with horners syndrome show the following signs of the affected eye. Horners syndrome, also known as oculosympathetic paresis, is a combination of symptoms that arises when a group of nerves known as the sympathetic trunk is damaged. Horners syndrome is a rare condition characterized by miosis constriction of the pupil, ptosis drooping of the upper eyelid, and anhidrosis absence of. Horners syndrome is a mix of symptoms that are caused when theres a disruption in the path of the. Once a thorough evaluation on the cause of horners syndrome has been performed, ptosis repair is an option. Simoens p et al 1990 horner s syndrome in the horse a clinical, experimental and morphologic study. Horner syndrome is a relatively rare disorder characterized by a constricted pupil. The diagnosis of horner syndrome and the localization of the lesions that cause the disorder can be determined by pharmacological tests combined with imaging techniques such as. Theres no specific treatment for horner syndrome, but. On examination, there was mild right upper eyelid ptosis and anisocoria, more pronounced in the dark, with the right pupil smaller than the left. Horner syndrome may be a sign of a serious condition such as a stroke or aneurysm. Ptosis is very mild and in rare cases affects vision in horner syndrome. Horner syndrome hs is a neurological disorder characterized by a symptom triad of miosis an abnormally small pupil, partial ptosis drooping of the upper eyelid, and facial anhidrosis absence of sweating. This article discusses what causes horners syndrome and how to diagnose the condition.
Selective mr imaging approach for evaluation of patients with horners syndrome kathleen b. The underlying causes of horners syndrome vary greatly and may include a tumor, stroke, injury. Horner syndrome secondary to internal carotid artery dissection after. Horners syndrome genetic and rare diseases information. This article discusses what causes horner s syndrome and how to diagnose the condition. For language access assistance, contact the ncats public information officer. Horner s syndrome is easily diagnosed by the presence of the signs listed above. Horners syndrome free download as powerpoint presentation. The signs and symptoms occur on the same side ipsilateral as it is a lesion of the sympathetic trunk. The syndrome was first described clinically by horner 1 in 1869, and he recognized that the phenomenon was secondary to paralysis of the nerves of the cervical portion of the sympathetic system. Horner syndrome is an eponym used to describe the clinical triad of ptosis, miosis, and anhidrosis caused by interruption of the ipsilateral first, second, or thirdorder sympathetic neurons to the head, eye, and neck. Horner s syndrome is a common condition in veterinary patients, particularly in dogs and cats, presenting with the typical features of miosis, enophthalmos, protrusion of the third eyelid and ptosis.
Horners syndrome is a diagnosis by exclusion where all other possible causes like trauma, tumours etc are ruled out before a diagnosis is made. The association between abducens nerve palsy and thirdneuron horners syndrome is an important diagnostic sign because it is localized to a cavernous sinus lesion, such as aneurysm or tumor. Rarely, the eyerelated symptoms will become fixed even between headache attacks. Horner syndrome brain, spinal cord, and nerve disorders.
Horners syndrome and apraclonidine eye drops practical. It can have many different symptoms, such as small pupils or droopy. Horners syndrome is a mix of symptoms that are caused when theres a disruption in the path of the nerves that run from the brain to the face. What are the signs and symptoms of horner syndrome. Horner syndrome is a classic neurologic syndrome whose signs include miosis, ptosis, and anhidrosis. Horner syndrome is a rare but fortunately nonlifethreatening neurological sequela of thyroid surgery. Horners syndrome is an autonomic disorder resulting from an interruption of the oculosympathetic nerve pathway between. Sir, a 46yearold man presented with a droopy left upperlid associated with headache, facial, and neck pain. Horners syndrome secondary to neuroblastoma cruz et. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. Answer horners syndrome usually is caused by some kind of damage to a string of nerves that help control your eyes, heart rate, sweat, and blood pressure. The significance of horners syndrome lies in the underlying diseases that cause this syndrome, rather than a clinical disease by itself.
Horner syndrome consists of unilateral ptosis, an ipsilateral miotic but normally reactive pupil, and in. Horner syndrome horner syndrome hs is oculosympatheticparesis loss of sympathetic innervation to the eye no major loss of ocular function vision and pupil reflexes remain intact the disorder is largely asymptomatic and oftenclinically subtle little need for therapeutic intervention hs may be caused by lesions associated. Horner syndrome consists of unilateral ptosis, an ipsilateral miotic but normally reactive pupil, and in some cases, ipsilateral facial anhidrosis, all resulting from damage to the ipsilateral oculosympathetic pathway. If a postganglionic lesion is present peripheral horner syndrome, the pupil of the affected eye dilates much more than that of the unaffected eye because the iris dilator muscle of the affected eye has lost its sympathetic innervation and has developed adrenergic supersensitivity. Patients with congenital horners syndrome who seemed, on the basis of their clinical history and the distribution of anhidrosis, to have a preganglionic lesion had partial mydriatic failure with hydroxyamphetamine hydrobromide and a supersensitivity to phenylephrine hydrochloride. The features of horner syndrome are miosis, ptosis, enophthalmos, and anhidrosis on the same side as the etiologic pathology. Diagnosis of horners syndrome in dogs and cats in practice. It is considered as a syndrome for it includes several or a collection of symptoms. Horners syndrome hs, also called oculosympathetic paresis, is a rare but significant clinical entity resulting from the disruption of the sympathetic neuronal pathway from the hypothalamus to the eyes and face. We prospectively performed mr imaging in 33 patients with horners. Download article pdf view full text htmlmachine readable. Horners syndrome was noted in the left eye with a moderate ptosis and an anisocoria, most prominent in dark. Although the presence of a horners syndrome was irrefutable on.
Learn more about the diagnosis and treatment of horners syndrome. Also called oculosympathetic paresis, a horner syndrome can be produced by a lesion anywhere along the sympathetic pathway that supplies the head, eye, and neck. Its causes include tumours, aneurysms, neck and chest surgery, and neck and chest trauma. Selective mr imaging approach for evaluation of patients. The association between abducens nerve palsy and thirdneuron horner s syndrome is an important diagnostic sign because it is localized to a cavernous sinus lesion, such as aneurysm or tumor. Horners syndrome is a rare condition affecting the nerves to the eye and face. This can be corrected by cosmetic surgery or treated with eyedrops. Congenital horners syndrome jama ophthalmology jama network. Chronic persistent horners syndrome in trigeminal autonomic. A rare congenital form of horner s syndrome is described. Horner syndrome is the result of another medical problem, such as a stroke, tumor or spinal cord injury. Treatment depends on the underlying cause of the condition. Horner s syndrome, also known as oculosympathetic paresis, is a combination of symptoms that arises when a group of nerves known as the sympathetic trunk is damaged.
Typically, horner syndrome results in a decreased pupil size, a drooping eyelid and decreased sweating on the affected side of your face. Horner s syndrome is a rare condition characterized by miosis constriction of the pupil, ptosis drooping of the upper eyelid, and anhidrosis absence of sweating of the face. There is minimal documentation that the horners syndrome can be reversed if successful. Apraclonidine is a weak alphaadrenergic agonist that minimally dilates the pupil of a normal eye. It is characterized by miosis a constricted pupil, partial ptosis a weak, droopy eyelid, apparent anhydrosis decreased. It results from lesions affecting the sympathetic supply to the head and orbit. Introduction the term horner syndrome is commonly used in english speaking countries, whereas the term bernard horner syndrome is common in france horner syndrome horners syndrome results from an interruption of the sympathetic nerve supply to the eye.
As you know, horners syndrome causes ptosis a droopy eyelid, miosis a constricted pupil and anhidrosis loss of sweating on one side of the face caused from interruption of function of a nerve pathway. Despite such knowledge, the incidence of underlying malignancy in children with hs remains unclear and robust evidence to guide best. Horner syndrome can be caused by any interruption in a set of nerve fibers that start in the part of the brain called the hypothalamus and travel to the face and eyes. Treatment of superior sulcus tumor pancoast tumor surg clin north. Mar 28, 2017 horner s syndrome hs occurs when there is interruption of the oculosympathetic pathway osp. Horner syndrome is a rare disorder that affects males and females in equal numbers and may occur at any age, among any ethnic grouping in any geographic location. Generally cases of horners syndrome resolve themselves. Horners syndrome, named after the ophthalmologist johann friedrich horner, is caused by a problem with the sympathetic nerve supply to one side of the face this disruption results in miosis, which is constricted pupil. We aimed to present a case with unilateral horners syndrome, which appeared in the morbidly obese parturient after lumbar epidural anaesthesia. Genetic and rare diseases information center gard po box 8126, gaithersburg, md 208988126 tollfree. Chiari i malformation is characterised by caudal descent of the cerebellar tonsils into the cervical spine and is associated with syringomyelia in 20% to 30% of cases. Isolated horners syndrome and syringomyelia journal of.
Horners syndrome symptoms, causes, treatment, pictures. Horners syndrome in dogs symptoms, causes, diagnosis. Horner syndrome after radical neck surgery for anaplastic. Horners syndrome bernardhorner syndrome, claude bernardhorner syndrome is caused by a lesion in the sympathetic nervous system and characterized by the classic triad of miosis, ptosis and decreased hemifacial sweating. Horners syndrome is a medical condition that is considered rare and basically affects a persons eye and face, specifically the persons nervous system.